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Home My WebLink About21533-zFORM NO.3* TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD. N.Y. N~ 21533 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: -~,', .~/,~......z .~..~ ....................................... .... ~'..~ ..~,,~....,..~y.:....~..../z ~ ..... at premises located at..../.i..~-.... ~ ~ ~" ~ CountyTax Map No. 1000 Sec,on ....... ,~'../....~.. ...... Block ............ ./.../. ......... Lot No ........ ,~'~. ............. pursuant to appllca,on dated ......... .~..~,?~'~/' ............................... 19..'~'~...'"'~ "'~ ..... Building Inspector, and approved by the /' ~f~ding'lnspector Rev. 6/30/80 MAP OF PROPERTY SURVEYED FOR ALBERT H, SILKWORTH ,~%T LIATE: AT MATTITUCK SUFFONK CO,~ N.~ TOWN 0F soL;z~q.!~L~_.. 5UI;L'V~'YI~D FEB, I, 19SI LIC. EN,~,E D SURVF_YOR TOWN OF ~c~j'mcn~ ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined . ~.//~.. ......... 19~. Approved.: .~.~.~.-- ........ 19f~. Permit No...~.. ?.~.~..~. / Disapproved a/c ' :"' ........ :".'"': ............ .... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ...... -... SURVEY ................... CIIECK .... ; ............... SEPTIC PORH .............. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se{s of plans, accurate plot plan to scale. Fee according to schedule. . b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti-eets or, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted bY the Building Inspector. · APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, ~uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in b.u. ilding for necessary~ -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. .'. ' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~.~...' ......... Plumber's License No ......................... Electrician s License No ....................... 1. LocationJflandonJhichpr0posed~/~v.orkwiilbedone. /.¢'~'.O..~). ..........: ........ , ........... , ....... .............................. '.: ............. ltouse Number Street Hamlet Cou'nty Tax Map No. 1'000 Section ./~.~.. ...... Block .... t/../. ' Lot../~. ............. Subdtwsion,.: .................................. Filed Map-No. - .- ............. Lot ............... 2: Stat~ existing use and occupancy of premises and intended use and occupancy, of proposed construction: a. Existing use and occupancy ...... [... ....... b. Intended use and occupancy ......................... :..'} ...;; ,...; .................. · 3.Nature of work (check which applicable): New Budding .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .... : ........ :J~4~t~l~r ~,¥ork .~...~'~...C~?. ..... · "' (~scfiption) 4. Estimated Cos~/~. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... . Number of dwelling units on each floor ................ . If garage, number ofc~s ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of.each type of use ..................... 7. D~mensmns ol emsung structures, if any' Front..~ Rear ~ Depth ~ Height ~ ............. Number of Stones ........................................................ l~D~ensions ofshme structure with a terations or additions Front Z~.( ............ Rear ~7-( ............. Dep~ . .~ ~ ................. HeiSt ........... · ........... Number of Stories ........... : .......... 8. Dimensions of entire new construction: Front .............. : Rear ............... Depth ............... Height Number of Stories . 10. Date of Purchase ..... ~.~ .............. Nome of Fo~er Owner ~ Z, ~ ........ 11. Zone or use district in which dremises are situated . .~ ~. ............... ~[~.[..~[~[[~[[~ 12. Does proposed construction violate any zoning law, ordinance or regulation: . ~ ....................... 13. W~l lot be regraded .... ~.: .................. Will ex,ss fill be removed from premises: Yes ~ 14. Owner of t& ..... ..... · Nme of ~chitect .... ~ ..................... Address ................... Phone No ................ Nme of Contractor~.~ ~ ........... Address .~.~.~. Phone~o. ~:~ ~... 15. Is th~s property w~thin 300 feet of a t~dal ~et~and. *Yes ...... No ~. ~If yes, Southold To~n Trustees Permit may be required. PLOT DIAG~ Locate clearly ~d distinctly ~I build~gs, Whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whether ~te~or or corner lot. STATE OF N~YOR~ ;/./"' o S ' COUITFY OF ._~?~..L,fl....[..1. ff~. ~' · . · -.-~.~( ~ .... ~: .(~.~.{~. ...... · ......... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, cotporate officer, etc.) of said owner or owners, ~d is duly authored to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ~ ' dayof ~I~ ~ .~ ,1~ ' ~ L OL~ ' .. ~.'..~..~ ....... : ..................... ~. ~9505 f~ (Signature of app]ic~t)